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Metabolic risk factors for stroke and transient ischemic attacks in middle-aged men: a community-based study with long-term follow-up
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.ORCID iD: 0000-0003-2247-8454
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2006 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 37, no 12, 2898-2903 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: The impact of lipometabolic and glucometabolic disturbances on stroke incidence remains to be characterized in detail. We investigated relations of a comprehensive panel of baseline lipometabolic and glucometabolic variables to incident fatal and nonfatal stroke or transient ischemic attack (TIA), and stroke subtypes. METHODS: A community-based prospective study of 2313 middle-aged men invited to a health survey at age 50. RESULTS: During a follow-up of up to 32 years, 421 developed stroke or TIA. In Cox proportional hazards analyses adjusting for treatment with cardiovascular drugs at baseline, 1-standard deviation increases in body mass index, systolic and diastolic blood pressures, serum proinsulin, and lipoprotein(a) were associated with 11 to 35% increased risk for subsequent stroke/TIA. Electrocardiographic left ventricular hypertrophy and smoking were also associated with a higher risk for stroke/TIA. Essentially the same variables were related to brain infarction/TIA. Higher proportions of palmitic (16:0), palmitoleic (16:1), and oleic acid (18:1) in cholesterol esters were associated with an increased risk, whereas a higher proportion of linoleic acid (18:2 n-6) was protective against stroke/TIA. Further adjusting all models also for hypertension, diabetes, the metabolic syndrome, serum cholesterol, atrial fibrillation, cardiovascular disease, smoking, and physical activity, essentially the same pattern was observed. CONCLUSIONS: Indices of an unhealthy dietary fat intake and a high serum lipoprotein (a) level predicted fatal and nonfatal stroke/TIA independently of established risk factors in a community-based sample of middle-aged men followed for 32 years.

Place, publisher, year, edition, pages
2006. Vol. 37, no 12, 2898-2903 p.
Keyword [en]
fatty acids, lipoproteins, risk factors, stroke
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-18469DOI: 10.1161/01.STR.0000249056.24657.8bISI: 000243411500018PubMedID: 17053177OAI: oai:DiVA.org:uu-18469DiVA: diva2:46241
Available from: 2006-12-21 Created: 2006-12-21 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Risk Factors for Stroke in Adult Men: A Population-based Study
Open this publication in new window or tab >>Risk Factors for Stroke in Adult Men: A Population-based Study
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the last decades our knowledge concerning cardiovascular risk factors has grown rapidly through results from longitudinal studies. However, despite new treatment, in Western countries coronary heart disease remains the leading cause of death and stroke is still the leading cause of severe disability.

The studies reported in these papers examine the relationships between stroke/transient ischaemic attack (TIA) and a number of different factors measured on two different occasions in men born in Uppsala 1920-1924 and are epidemiological in their character.

The findings indicate that in addition to already established risk factors, indices of an unhealthy dietary fat intake and high serum lipoprotein(a) are independent predictors of stroke/TIA. Among different glucometabolic variables a low insulin sensitivity index derived from the euglycaemic insulin clamp and proinsulin carries a high predictive value for later stroke, independently of diabetes.

Moreover, cognitive test performance measured with Trail Making Test B at age 70 is a strong and independent predictor of brain infarction, indicating that the risk is already increased in the subclinical phase of milder cognitive dysfunction. Performance at a pre-stroke Trail Making Test is also of predictive value for mortality after first-ever stroke/TIA, but none of the studied pre-stroke variables or cognitive tests was found to be related to dependency after an event.

In summary these studies provide further knowledge about predictors of stroke and of mortality after first-ever stroke. They also indicate the possible importance of new markers of risk, such as the level of lipoprotein(a), profile of fatty acids in the diet, low insulin sensitivity derived from clamp investigations, level of proinsulin, and cognitive performance measured with Trail Making Tests.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 540
Keyword
risk factor, stroke, TIA, lipoproteins, fatty acids, insulin resistance, proinsulin, clamp, cognitive function, epidemiology, Trail Making Test, stroke mortality, dependency
National Category
Geriatrics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-120542 (URN)978-91-554-7753-0 (ISBN)
Public defence
2010-05-11, Konferenssalen, Blå Korset, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
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Supervisors
Available from: 2010-04-20 Created: 2010-03-12 Last updated: 2011-06-28Bibliographically approved

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Wiberg, BerniceSundström, JohanÄrnlöv, JohanTerént, AndreasVessby, BengtZethelius, BjörnLind, Lars

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